Review of a staistical study

¶ … Improving Patient Satisfaction

Studies have shown time and again that patient satisfaction is associated with quality of care perceptions. In addition, national accrediting agencies such as the Joint Commission on the Accreditation of Healthcare Organizations have cited patient satisfaction as a high priority for healthcare providers. Because resources are by definition scarce, it is important for healthcare providers to determine the most cost-effective approach to improving patient satisfaction, particularly during the current period of budget cutbacks and economic downturns. A study by Meade, Bursell and Ketelsen (2006) analyzed the effectiveness of varying times for nursing rounds in improving patient satisfaction as well as the concomitant incidence of patient falls. This paper provides a review and analysis of the Meade et al. study to identify its strengths and weaknesses.

1.

Problems and Purposes

According to Meade and her associates, there is a paucity of timely research concerning the use of call lights by inpatients as it applies to improving patient-care management, patient safety, and patient satisfaction. When ill, groggy or semi-conscious patients are left to their own devices, they may attempt to leave their hospital beds in order to visit the bathroom, ask a question or simply to stretch their legs not recognizing the dangers inherent in ambulation prematurely and may experience an injurious fall as a result. Moreover, based on their empirical observations, patients frequently use their call lights for reasons that could be resolved by a certified nursing assistant rather than a licensed practical nurse (LPN) or registered nurse (RN). Given the current and projected shortage of nurses in the United States, any time spent on unessential patient care issues represents an added burden for LPNs and RNs and may further exacerbate job dissatisfaction and burnout and even cause the healthcare professional to leave the profession.

2.

Research Objectives, Questions, and Hypotheses

In order to fill the existing gap in the literature, the research objectives of the study by Meade et al. were two-fold, with the first objective being (a) to examine how often patients used their call lights and for what purposes, as well as the impact of varying nursing rounds from 1 to 2 hours on patient satisfaction and patient safety defined as the incidence of patient falls and (b0 the second objective to determine how much time LPNs and RNs spend in responding to patient call lights and how this response time affected patient-care management. Based on the foregoing considerations, the researchers hypothesized that nursing rounds on medical, surgical, and medical -- surgical hospital units that were performed on a regular schedule by nursing staff who perform a specific set of actions, would accomplish the following: (a) reduce call light use; (b) increase patient satisfaction; and (c) improve patient safety, as measured by the frequency of patient falls.

3.

Variables in Published Studies

The variables used in the subject study by Meade and her colleagues consisted of varying the nursing round times from 1 to 2 hours.

4.

The Literature Review

The researchers present a brief but fairly comprehensive review of the literature in support of their hypothesis. As noted above, there is a lack of timely studies concerning the use of call lights by patients but the researchers cite several studies that support their position, at least in a general fashion.

5.

Framework of the Study

The framework for the study was a nationwide quasi-experimental nonequivalent groups design for a 6-week period.

6.

Study Design

The researchers describe their study design as "quasi-experimental" because of its unique nature. The baseline data for the study was recorded during the first 2 weeks of the 6-week study period. The study design consisted of analyses of the data collected from the experimental (1-hour rounds and 2-hour rounds) versus the control nursing units with a nonrandom assignment of hospital units to these respective groups (the assignment was the responsibility of chief nursing officers and nurse managers). Although the determined to conduct 1-hour or 2-hour nursing rounding was left up to the nursing executives at the participating hospitals, the principal investigator ensured that the sample was stratified as to type of unit (i.e., medical, surgical, or combined medical -- surgical), unit size, and frequency of nursing rounds.

7.

Adequacy of the Sample

The researchers identified 26 different reasons for the use of call lights by patients in their review of the literature and coded data from the 14 hospitals whose data satisfied the study criteria according to these reasons. The study examined 108,882 episodes of call light use from 27 units of these 14 hospitals during a 6-week period; the researchers report that the mean answers of call lights was 4,381.7 in the 15 experimental units in which the nursing round times were varied (total number of call lights answered was 65,726) and the mean for call light answers in the 12 control units was 3,596.3 (total number of call lights answered was 43,156).

8.

Directness of Measurement

The researchers ensured that adequate recordation procedures were in place at the participating hospitals for nursing staff to log the reasons for call light use by patients, although these procedures sometimes varied from unit to unit, with some hospitals using a manual approach while others enjoyed the use of an automated system.

9.

Measurement Error

The researchers acknowledge that they did not have access to the raw statistical data but were compelled to rely on the vendors at each hospital who supplied mean satisfaction scores for each unit, the sample sizes, and standard deviations; Meade and her associates, though, note that this data was sufficient for their t test calculations.